Pre-travel vaccine information needs, attitudes, drivers of uptake and the role for decision aids in travel medicine

Unveiling the complexity of vaccine hesitancy: A narrative review focusing on dengue vaccination

Dengue vaccines face significant challenges, including safety concerns, which contribute to vaccine hesitancy. Addressing this complex issue requires targeted strategies to overcome existing barriers. Through an extensive review of current evidence, we identified key factors contributing to vaccine hesitancy and explored strategies to enhance global vaccine uptake. Four conceptual models and five assessment tools were identified to understand and measure vaccine hesitancy. Among the factors, "confidence" emerged as the most influential, followed by "complacency." Vaccine acceptance rates varied widely, ranging from 53% to 95%, depending on the region and population. Key determinants included population characteristics, concerns about efficacy and safety, among others. A comprehensive understanding of these factors is essential to improve vaccine acceptance, support dengue prevention efforts, and ensure public health success.

Polish travellers on the move: A study of knowledge of travel health and associated practices among polish travellers abroad

BACKGROUND

Post-pandemic travel has surged, with 1.3 billion journeys recorded worldwide in 2023, reflecting a growing interest in tropical destinations despite the associated health risks. Access to travel health information has improved, yet adherence to preventive measures remains limited due to misinformation, insufficient pre-travel consultations, and concerns about malaria prophylaxis. Based on data from a three-year survey, this study examines the attitudes of Polish travellers to vaccinations, malaria prophylaxis, and COVID-19-related measures.

METHODS

Surveys conducted during travel festivals from 2021 to 2023 targeted adult participants. A questionnaire designed by experts in travel medicine addressed the demographics, travel behaviours, and health-related practices. Statistical analyses, including chi-squared tests and logistic regression, explored the impact of demographic factors on behaviours, using Python for data analysis.

RESULTS

Among 644 participants (mean age 32; 48 % male), 49.5 % reported pre-travel vaccination and 281 intended to use malaria chemoprophylaxis. Gender significantly influenced vaccination status and travel to Africa. The most cited malaria prevention methods were repellents and mosquito nets. Illnesses were reported by 317 participants, with travellers' diarrhoea (185 cases) most common, particularly in Turkey, Egypt, and India. Forty-eight individuals required medical consultations.

CONCLUSIONS

Education and pre-travel counseling enhance adherence to preventive measures, yet many travellers fail to follow recommendations. Malaria remains the most common travel-imported disease in the EU/EEA, with 4856 cases in 2021. The Capability, Opportunity, and Motivation Behavior (COM-B) model highlights the importance of addressing these factors to improve compliance with preventive behaviours.

The Deadly Details: How Clear and Complete Are Publicly Available Sources of Human Rabies Information?

Human rabies is preventable but almost always fatal once symptoms appear, causing 59,000 global deaths each year. Limited awareness and inconsistent access to post-exposure prophylaxis hinder prevention efforts. To identify gaps and opportunities for improvement in online rabies information, we assessed the readability, understandability, actionability, and completeness of online public rabies resources from government and health agencies in Australia and similar countries, with the aim of identifying gaps and opportunities for improvement. We identified materials via Google and public health agency websites, assessing readability using the Simple Measure of Gobbledygook (SMOG) index and understandability and actionability with the Patient Education Materials Tool for Print materials (PEMAT-P). Completeness was assessed using a framework focused on general and vaccine-specific rabies information. An analysis of 22 resources found a median readability of grade 13 (range: 10-15), with a mean understandability of 66% and mean actionability of 60%; both below recommended thresholds. Mean completeness was 79% for general rabies information and 36% for vaccine-specific information. Visual aids were under-utilised, and critical vaccine-specific information was often lacking. These findings highlight significant barriers in rabies information for the public, with most resources requiring a high literacy level and lacking adequate understandability and actionability. Improving readability, adding visual aids, and enhancing vaccine-related content could improve accessibility and support wider prevention efforts.

Vaccine Acceptance among travelers directed to areas with risk of dengue: a pilot study

Introduction

Dengue is a vector-borne viral disease that causes a million of cases every year (including deaths). A tetravalent live-attenuated virus vaccine is available for this infection. The aim of our work was to study vaccine acceptance, attitudes and behaviors among travelers heading to areas with risk of dengue.

Methods

We conducted a cross-sectional study in February-April 2024 at the Travel Medicine Clinic of Rozzano (Italy), focusing on travelers directed to areas with risk of dengue. We collected the following information anonymously: travel destination, reason for travel, date/month of departure, length of stay, and accepted/refused vaccinations.

Results

58 travelers were included in our study and they chose 23 countries for their travel with a mean length of stay of 16.98 days. Five (8.62%) refused dengue vaccination because they considered the vaccination not necessary (80%), or for its cost (20%). There was no statistically significant difference between men and women in vaccination acceptance. Age and length of stay did not influence the percentage of refusals.

Conclusions

Although the results are limited by the small number of travelers, they highlighted the problem of vaccine hesitancy among travelers, and further efforts are needed to address this phenomenon.

Rabies knowledge gaps and risk behaviour in Dutch travellers: An observational cohort study

BACKGROUND

Travellers visiting rabies-endemic countries are at risk of rabies infection. Assessing travellers' knowledge and risk perception of rabies and risk behaviour during travel can help identify knowledge gaps and improve pre-travel risk education.

METHODS

Cohort study in Dutch adult travellers, using two surveys: one before travel to assess knowledge and perception of rabies, and one after return to identify risk behaviour during travel.

RESULTS

The pre-travel and post-travel survey were completed by 301 and 276 participants, respectively. 222 participants had travelled to a high-risk rabies-endemic country. 21.6 % of the participants scored their rabies knowledge as poor. Some participants were unaware cats or bats can transmit rabies (26.6 % and 13.6 %, respectively), or that post-exposure prophylaxis (PEP) is required for certain exposures such as skin abrasions without bleeding or licks on damaged skin (35.5 % and 18.9 %, respectively), while 27.9 % of participants did not know PEP needs to be administered within one day. 115 participants (51.8 %) reported any form of contact with any animal during travel. Two participants reported animal exposure, of which one took adequate PEP measures. Risk factors for animal contact abroad were regularly touching cats or dogs at home or abroad, longer travel duration, having pets during childhood and being an animal lover.

CONCLUSIONS

Pre-travel rabies risk education currently does not meet travellers' needs, which is reflected in knowledge gaps and engagement in risk behaviour during travel. During pre-travel health advice, avoiding animal contact abroad should be emphasized, and additional education is required about indications for PEP.

The Ready-To-Go Questionnaire predicts health outcomes during travel: a smartphone application-based analysis

BACKGROUND

The Ready-To-Go (R2G) Questionnaire is a tool for rapid assessment of health risks for travel consultation. This study aims to assess the utility of the R2G Questionnaire in identifying high-risk travellers and predicting health events and behaviour during travel in the TOURIST2 prospective cohort.

METHODS

TOURIST2 data were used to calculate the R2G medical and travel risk scores and categorize each participant based on their risk. The TOURIST2 study enrolled 1000 participants from Switzerland's largest travel clinics between 2017 and 2019. Participants completed daily smartphone application surveys before, during and after travel on health events and behaviours. We used regression models to analyse incidence of overall health events and of similar health events grouped into health domains (e.g. respiratory, gastrointestinal, accident/injury). Incidence rate ratios (IRR) are displayed with 95% confidence intervals (95% CI).

RESULTS

R2G high-risk travellers experienced significantly greater incidence of health events compared to lower-risk travellers (IRR = 1.27, 95% CI: 1.22-1.33). Both the medical and travel scores showed significant positive associations with incidence of health events during travel (IRR = 1.11, 95% CI: 1.07-1.16; IRR = 1.07, 95% CI: 1.03-1.12, respectively), with significant increases in all health domains except skin disorders. Medical and travel risk scores were associated with different patterns in behaviour. Travellers with chronic health conditions accessed medical care during travel more often (IRR = 1.16, 95% CI: 1.03-1.31), had greater difficulty in carrying out planned activities (IRR = -0.04, 95% CI: -0.05, -0.02), and rated their travel experience lower (IRR = -0.04, 95% CI: -0.06, -0.02). Travellers with increased travel-related risks due to planned travel itinerary had more frequent animal contact (IRR = 1.09, 95% CI: 1.01-1.18) and accidents/injuries (IRR = 1.28, 95% CI: 1.15-1.44).

CONCLUSIONS

The R2G Questionnaire is a promising risk assessment tool that offers a timesaving and reliable means to identify high-risk travellers. Incorporated into travel medicine websites, it could serve as a pre-consultation triage to help travellers self-identify their risk level, direct them to the appropriate medical provider(s), and help practitioners in giving more tailored advice.

Psychological and Social Aspects of Vaccination Hesitancy-Implications for Travel Medicine in the Aftermath of the COVID-19 Crisis: A Narrative Review

Vaccines are an important tool of preventive medicine. Although organized vaccination programs have saved large populations from serious infectious diseases, there is a considerable part of the population who oppose vaccinations. In particular, anti-vaccination perceptions, among travelers to countries with endemic diseases, are a major public health concern. Although hesitancy towards vaccinations is not a novel phenomenon, it came back to the forefront during the fight against the COVID-19 pandemic. This review explores the etiology of anti-vaccination beliefs among travelers and draws conclusions about their impact on public health and society in general. For this purpose, a purposeful search for data on the causative factors of vaccine hesitancy and their impact on people's health was conducted. A descriptive analysis of the findings and conclusions regarding possible implications in health policy and clinical practice are presented. A fear of side effects, lack of credence in the necessity of vaccines, and mistrust of medical authorities are important causative factors. Their interplay shapes hesitancy towards vaccines. However, anti-vaccination beliefs can also be an aspect of a more general unconventional stance of life. Health care professionals and organizations must be ready to tackle vaccine hesitancy by making the necessary interventions. Correcting misconceptions about vaccinations is a prerequisite for ensuring personal and public health, especially in the context of a pandemic or epidemic. Moreover, ensuring the efficacy and safety of vaccines, especially in cases of modern technology applications, is a fundamental factor in addressing people's concerns about vaccines. For this purpose, medical authorities and organizations must provide accurate and clear information on vaccines so as to eliminate misinformation. Furthermore, clinicians should cultivate their communication skills in order to convey the appropriate messages to prospective recipients of vaccinations.